Social Anxiety Help

More Than Just Shy:
Social Anxiety Disorder in Teenagers

Research Shows School-Based Intervention for SAD Helps
by Carrie Masia-Warner, Ph.D., Rachel G. Klein, Ph.D.,
and Paige Fisher, Ph.D., NYU School of Medicine, NYU Child Study Center

Anxiety Disorders Association of America:
ADAA Reporter, Sept-Oct 2003

Mary is a quiet 16-year old who does well in school, but she often keeps to herself. She doesn’t raise her hand in class, andshe avoids being around her classmates outside of class. She becomes extremely uncomfortable in unavoidable school gatherings, like gym class or in the cafeteria. Mary has few friends, mainly one or two girls she has known since grade school. Her parents and teachers think that she’s just shy. When they encourage her to be more outgoing, she often becomes more withdrawn, sometimes angry, so they leave her alone. They assume she’ll outgrow it on her own. What they don’t understand is that Mary may be more than shy; she may be suffering from social anxiety disorder.

Many parents and educators are unaware that anxiety is the most prevalent mental health problem in children. According to the U.S. Surgeon General’s report on mental health, 13 percent of children and adolescents suffer from anxiety disorders. Social anxiety disorder (SAD) is the most common anxiety disorder in teenagers and adults. Left untreated, it can have an impact on functioning. Knowing the signs of SAD, and the effective treatments available, can help many teens.

WHAT IS SOCIAL ANXIETY DISORDER?
Social anxiety disorder is characterized by an intense fear of social and performance situations. The most commonly feared situations include initiating conversations, unstructured peer activities, performing in front of others, speaking up in class, and inviting others to get together. Avoidance of these situations significantly interferes with the quality of youngsters’ lives, often impairing their school performance and attendance, as well as their ability to socialize with peers and to develop and maintain relationships. The onset of SAD peaks in adolescence when establishing and managing friendships independently is a crucial part of healthy development. Untreated, it can persist into adulthood and increase the risk for later depression or alcohol abuse.

HOW DO I KNOW IF MY TEENAGER HAS SAD?
Many teenagers with SAD go undetected and without appropriate treatment. Parents and teachers may not be aware of the warning signs of social anxiety, or may not consider extreme shyness as a problem warranting professional attention. Some signs to recognize are:

• Hesitance, passivity and discomfort when in the spotlight
• Avoidance or refusal to initiate conversations, perform in front of others, invite friends to get together, call others on the telephone for homework or other information, or order food in restaurants
• Avoidance of eye contact and speaks very softly or mumbles
• Minimal interaction and conversation with peers
• Appearing isolated and on the fringes of the group
• Sitting alone in the library or cafeteria, or hanging back from the group at team meetings
• Overly concerned with negative evaluation, humiliation or embarrassment
• Difficulty with public speaking, reading aloud, or being called on in class

UNTREATED SAD CAN HURT ACADEMIC PERFORMANCE
A teenager with SAD can have a difficult time in school. They may avoid participating in school activities, and feel a great deal of anxiety and distress related to such activities. They may have trouble asking a teacher for help with an assignment they don’t understand, causing them to struggle in their schoolwork. Presenting in front of the class often causes great anxiety and the student will try to put off presenting or will simply not do the assignment, regardless of how it would affect their grade. For those students who have been absent, missed work will often not be completed because the student will avoid having to ask a classmate or the teacher for the assignment.

For some students, being late for class is very distressing, as they do not want the attention of walking into class after everyone else. Some students will simply not go to class to avoid walking in late. Students with severe SAD may refuse to go to school; some may even drop out.

PROVIDING TREATMENT IN SCHOOLS
Given the detrimental consequences of untreated social anxiety, early detection and intervention is critical. Partnering with schools provides a rich opportunity to educate and raise awareness of school personnel, teachers, and parents in recognizing social anxiety. It could also make intervention more accessible to students who otherwise would likely not seek or receive treatment. In addition, peer support, as well as teacher assistance, would be available to help the student.

In an ADAA and Lowenstein Foundation supported study, a new behavioral program developed to treat SAD in the school setting has shown promising results. Results of the program-Skills for Social and Academic Success-found that:

• Only one-third of those students who received treatment through the program still met the criteria for SAD, compared to 94 percent of those who were not treated, and
  The severity of social phobia symptoms in those treated decreased significantly.
• Intervening in the schools has the potential to prevent long-term impairment by improving the recognition of SAD and facilitating access to treatment. Important next steps will be to train school professionals to deliver effective treatments and to further understand the barriers to seeking treatment for social anxiety.

Find out if SAD is a problem in your family. Self tests are available for parents and teens on the ADAA website at www.adaa.org. If you are a school professional and would like to learn more, please contact Dr. Carrie Masia-Warner at carrie.masia@med.nyu.edu.

Dr. Masia-Warner is an Assistant Professor of Psychiatry at NYU Child Study Center. She was the recipient of a Junior Faculty Research Award from the Anxiety Disorders Association of America to support her work on school-based intervention for social anxiety disorder.

TIPS TO HELP YOUR SOCIALLY ANXIOUS CHILD OR STUDENT

FOR PARENTS:

• Expose your child to different social situations, e.g., play groups, birthday parties, after school activities, where the child will have more chances to interact with his/her peers.
• Don’t speak for your child, but encourage him or her to speak up, e.g., when ordering food in a restaurant.
• Praise or offer rewards to your child for speaking up. For example, offer to take the child to the movies if he/she will ask for the tickets at the box office.
• Lead by example. Teach your child how to handle social situations by allowing him/her to see how you handle the situation.

FOR TEACHERS:

• Change your classroom procedures to get the child more involved.
• Explain to the student why you are doing this, that you want to help them feel more comfortable in class, and not trying to make them feel embarrassed.
• Remind them that speaking out in class will get easier with practice.
• Do not single the child out, but call on all students for answers.
• Incorporate public speaking into your curriculum, if possible. This will help all of your students develop confidence in speaking in front of others.

These tips were adapted from Triumph Over Shyness, by Murray B. Stein, M.D., and John R. Walker, Ph.D. This book is available through the ADAA Bookstore at http://www.adaa.org/bookstore/Onlinebookstore.asp.

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